Volume 9 Number 2 August 1995
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References1. Planning and Programming Department. Health Manpower Study: Staffing Pattern in Health Institutions. Ministry of Health, Addis Ababa,1992:1-5. 2. Mersha T, Tenagne D, Truworq T, Tsegaye S. Report on Evaluation of the Existing Curriculum for Nurses' Training in Ethiopia. Ministry of Health, Addis Ababa. 1990:1-19. 3. Addis Ababa University .Student Grading. Senate Legislation, Addis Ababa University , 1987:112-37. 4. Melakeberhan D, Melake D. A review of academic perforn1ance of medical students. Ethiop J Health Dev. 1994; 8:23-28. 5. Messeret S. Admission Criteria to School of Nursing. Training Department, Ministry of Health. 1993. 6. WHO. Nursing beyond the year 2000: Report of a WHO study group. WHO Technical Report Series. 1994; 842:6-10. 7. Ndlovu JR. Overview of Curriculum Development and Innovation, Integrating theory with practice and pedagogic approaches . Presented at the National Workshop of Nurses' Curriculum Assessment. Department of Training, Ministry of Health, Addis Ababa. . Nov.2-6, 1990. 8. Bogalech A. Curriculum development and instruction. Paper presented at the National Workshop of Nurses' Curriculum Assessment. Department of Training, Ministry of Health, Addis Ababa. Nov.2-6. 1990. Original article Prevalence of syphilis among Ethiopian blood donors Yonas Sisay1 and Yonas Tegene1 Abstract: The study was performed to asses the prevalence and distribution of syphilis among Ethiopian blood donors. Serological data of 21,846 blood donors obtained over two years peroid (1987-89) from five blood transfusion centers were analayzed. Syphilis testing was done using the rapid plasma reagin (RPR) test. Overall RPR reactivity of 3% to over 1 2% and sex specific rates of about 3% in females and over 4.5% in males were obtained following prior health screening, including information on risk factors such as sexually transmitted diseases, in the five regions studied. The male to female ratio was 1.5: 1. Distinct low and high seroprevalence centers, with overall rates of 3.0% -4.1% and 10.1 % -12.2%, respectively, were also observed. There was a statistically significant difference (P = 0.0004) in the RPR rate between the two sexes. There is a high prevalence of syphylis in Ethiopian blood donors who underwent prior health screening. Thus, universal syphilis screening of blood intended for transfusions in Ethiopia and Syphilis serostatus notification of blood donors are recommended. [Ethiop. J. Health Dev. 1995;9(1):91-103] IntroductionRecently, syphilis has emerged as a public health priority due to its association with HIV infection. There is a high prevalence of syphilis in many parts of Africa such as Mozambique(I), Zambia(2), Swaziland(3), Tanzania(4), and Somalia(5), in the various population groups studied. Reported prevalence of syphilis test seroreactivity in pregnant women attending antenatal clinics in Africa ranged from 4% - 15% (1,2,6-11). In surveys conducted in neighboring Somalia (12) and Tanzania(4), positive venereal disease research laboratory (VDRL) reactivity was observed in approximately 7% and 14% of blood donors, respectively. In Ethiopia, seroprevalence data on syphilis is limited to selected population groups. Data on the general population or groups more or less representative of the general population, such as blood donors are lacking. Blood used for transfusions is also not screened for syphilis markers in hospital blood banks currently not served by a regional blood bank of the Red Cross. However, sexually transmitted diseases are common accounting for over 5% of all visits to health institutions every year(13). Two previous studies have shown that 13% -15% of mothers attending antenatal clinics in Addis Ababa were VDRL reactive( 14). Of these about two-thirds of the infants of seropositive mothers were also VDRL reactive at birth, and 20% had clinical signs of congenital syphilis (15). A Study of in-patiemsdone in Ethiopia in 1982 has shown a syphilis test reactivity of about 10% , using the treponema palladium hemagglutination (TPHA) test (17). Moreover, 16% and 22% of syphilitic inpatients had congenital and cardiovascular syphilis, respectively (17). In addition 38% of prostitutes in Addis Ababa were found to be seroreactive or syphilis in 1990(18). It has also been estimated that 5% of all pregnancies in Ethiopia are lost because of syphilis, which is an estimated loss of 75,000 pregnancies each year(16). Congenital Syphilis is the fourth major cause of perinatal mortality in Ethiopia. The high seropositivity rates for syphilis and the seriousness of its complications have prompted the suggestion .for routine syphylis screening of patients visiting health care facilities (17, 19). _______________________________
Red Cross Society, P.O.Box 195 , Addis Ababa, Ethiopia
Baseline prevalence and distribution data on syphilis are important for three main reasons: (1) for the prevention and control of the infection and its sequelae, such as congenital syphilis, (2) for the indirect evaluation of the effectiveness of HIV control programs by monitoring syphilis serology, and (3) for the formulation of policy on screening of blood nation wide. The present study aims to describe the prevalence and distribution of siphilis among Ethiopian blood donors. MethodsBlood bank data of 21,846 donors was analyzed for syphilis serology. These data included 18,418 donors of the Addis Ababa blood transfusion center (October 1987 to September 1989) and 3428 donors of four regional blood banks (January to June, 1989). the four regional blood banks that participated in the study were Asmara, Harar , Yirgalem, and Jima centers. All blood donors filled a standard blood bank questionnaire, underwent routine physical examinations, and then were apparently healthy and eligible to donate blood. Sera were coded and examined the same day. All the 21,846 sera were tested for syphilis using 18 mm RPR card test (Brewer Diagnostics). All reactive sera were retested using the same kit. Controls with established patterns of graded reactivity were used in each day's testing. Statistical analyses included regional, age and sex specific RPR reactivity rates, and a test of significance (chi square test) (Figure 1). 
Results The prevalence of RPR positivity among blood donors of the five regions of Ethiopia is shown in the table below. The overall pooled prevalence rate was 4.5% in males and 3.0% in females. The range was 3%-12% in males and 0%-13.3% in females. Two distinct syphilis seroprevalence regions i.e. high and low prevalence centers, have been observed. Low prevalence centers were Asmara and Addis Ababa with overall rates of 3.0% and 4.1%, respectively. High prevalence centers were Jimma (10.1%), Yirgalem (10.9%) and Harar (12.2%). The differences in regional rates were statistically significant [ p < 0.01, four degrees of freedom, and X2 = 130.01]. Of the two sexes, male donors in all centers except Yirgalem, showed higher prevalence rates as opposed to female donors. The difference in RPR reactivity rates between the two sexes was statistically significant (p = 0.0004), and the male to female ratio was 1.5:1. Figure 1 shows age and sex specific RPR positivity rates among blood donors of the Addis Ababa Center. Syphilis seroprevalence rises steadily from the age of 18 years (the lower age limit for blood donation) to 30-34 years in both sexes, remaining nearly the same through the age group of 35-44 years. Peak RPR positivity rate was observed in females in the late ages of 55-64 years. |